腭裂患者鼓膜穿孔的非手术治疗效果

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Alexander Poulakis , Michael S. Castle , Matthew M. Carter , Nathan D. Vandjelovic
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引用次数: 0

摘要

腭裂儿童(CP)的咽鼓管功能障碍发生率较高,导致慢性中耳炎,频繁放置鼓膜造瘘管(TT),并最终导致鼓膜穿孔(TMP),尽管该人群中TMP的自然过程尚未描述。方法采用电子病历工具对某三级学术医疗中心诊断为CP并有TT置换术或TMP修复史的患者进行鉴定。通过手工检查确定慢性TMP患者。分析了穿孔质量、分辨率和其他结果。慢性TMP被定义为耳镜检查中间隔至少3个月出现的TM缺陷,而TMP消退被定义为任何后续评估中完整的TM。结果共对166只耳进行了分析。64只耳朵(60%)发展为慢性TMP,其中43只耳朵(67%)未经干预观察。21例(49%)观察到TMPs自发消退,近一半在1年内发生。愈合穿孔中无胆脂瘤发生。如果TT持续时间小于2年,TMP缓解的发生频率明显更高(13/16 = 81% vs . 6/18 = 33%, p = 0.0138),但在逻辑回归分析中,控制年龄和地点后,没有发现显著影响。在控制年龄和TT插管时间的情况下,TMP尺寸越小,解决时间越短(OR = 1.23x10−8;p = 0.041)。结论耳部疾病的自然病程不同,CP的存在会影响管理决策。穿孔在1年内自行愈合的机会最大,术后手术闭合对其最有利。了解关闭率可能对TMP管理策略有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-operative tympanic membrane perforation outcomes for cleft palate patients

Introduction

Children with cleft palate (CP) have higher rates of eustachian tube dysfunction, leading to chronic otitis media, frequent tympanostomy tube (TT) placement, and ultimately tympanic membrane perforation (TMP), though the natural course of TMPs in this population has yet to be described.

Methods

An electronic medical record tool was used to identify patients with a diagnosis of CP and previous TT placement or TMP repair at a tertiary academic medical center. Patients with chronic TMP were identified by manual review. Qualities of the perforation, rate of resolution, and additional outcomes were analyzed. Chronic TMP was defined as a TM defect present on otoscopy at least 3 months apart, while TMP resolution was defined as an intact TM on any subsequent evaluation.

Results

One hundred-six total ears were analyzed. Sixty-four (60 %) ears developed a chronic TMP, of which 43 (67 %) were observed without intervention. Twenty-one (49 %) observed TMPs resolved spontaneously, nearly half of which occurred within 1 year. No instances of cholesteatoma developed among healed perforations. TMP resolution occurred significantly more frequently if preceded by TT duration less than 2 years (13/16 = 81 % v. 6/18 = 33 %, p = 0.0138), but no significant effect was noted when controlling for age and location on logistic regression analysis. Time to resolution was significantly shorter with smaller TMP size when controlling for age and duration of TT intubation (OR = 1.23x10−8; p = 0.041).

Conclusion

The presence of CP influences management decisions as the natural course of ear disease may be different. Perforations have the greatest chance to self-resolve within 1 year and may benefit most from operative closure thereafter. Knowledge of the rate of closure may be useful in TMP management strategies.
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来源期刊
CiteScore
3.20
自引率
6.70%
发文量
276
审稿时长
62 days
期刊介绍: The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.
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